https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1538-7836.2009.03385.x

Heparin-induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is an adverse prothrombotic disorder caused by an immune response to complexes of platelet factor 4 and polyanions. The clinical relevance of HIT results from the wide use of heparin, which is the reason that the absolute number of patients affected by HIT is high. HIT is currently the most frequent immune-mediated adverse drug reaction affecting blood cells.

/pdf/heparin-induced-thrombocytopenia-2jdgie3gzs.pdf

Heparin-induced thrombocytopenia.

Pacemaker lead thrombosis treated with atrial thrombectomy and biventricular pacemaker and defibrillator insertion.

Heparin‐Induced Thrombocytopenia

Recombinant hirudins have a definite role in the treatment of patients with heparin-induced thrombocytopenia (HIT). The most important adverse effects are haemorrhages and the induction of antihirudin antibodies. Major haemorrhages were not significantly increased in patients with HIT compared with a historical control group, but prospective data comparing hirudin and heparinoids such as danaparoid are lacking. The definition of the optimal method for monitoring and the availability of an antidote for hirudin would probably increase safety with this drug. To date, haemofiltration using high-flux filter systems is the only way to remove an overdosage of hirudin from the circulation. In patients with renal impairment requiring hirudin treatment, it therefore seems safer to start with a low dose that is subsequently adjusted according to the activated partial prothromboplastin time or ecarin clotting time. Even in special circumstances, such as cardiopulmonary bypass or dialysis, hirudins can be applied successfully if care is taken to monitor their effects meticulously. There are many other indications in which hirudins have shown feasibility (e.g. acute coronary syndromes) but available data preclude definite conclusions.

Heparin-Induced Thrombocytopenia Recommendations for Optimal Use of Recombinant Hirudin

Only few reports exist addressing the problem of temporary pacemaker leads associated with thromboembolic disease. We report the case of a 67-year-old patient who required a temporary transfemoral pacemaker due to AV block grade III. The patient developed extensive right atrial and ventricle thrombus formation attached to the pacing wire, as well as venous thrombosis at the insertion site due to heparin-induced thrombocytopenia type II (HIT type II). After short-term thrombolysis with 1 mg rt-PA/kg b.w. complete resolution of all clots could be shown by B-mode sonography and transthoracic, as well as transesophageal echocardiography.

Successful thrombolysis of right atrial and ventricle thrombi encircling a temporary pacemaker lead in a patient with heparin-induced thrombocytopenia type II.

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Successful thrombolysis of right atrial and ventricle thrombi encircling a temporary pacemaker lead in a patient with heparin-induced thrombocytopenia type II.